2-037 Enhancing bedside echocardiography documentation in out-of-hospital cardiac arrest: a standardized protocol

Introduction In patients with out-of-hospital cardiac arrest (OHCA), a bedside transthoracic echocardiogram (TTE) is vital for identifying the underlying cause of the arrest and guiding management. However, in busy cardiac catheterisation labs (CL) and cardiac arrest centres (CAC), TTE findings can often be overlooked or be inconsistently documented. Observations in busy CACs showed that TTE results, although integral to patient care, were often not documented due to time constraints, and when documented, were dispersed throughout patient records. This leads to critical information gaps that can impede rapid handovers during emergencies. Aims This observational study aimed to improve the documentation and accessibility of initial TTE findings in OHCA patients by: Ensuring that bedside TTE results are documented in a readily accessible format. Achieving comprehensive documentation of five key parameters: left ventricle (LV), right ventricle (RV), valves, pericardial effusion, and aorta. Methods At a busy CAC in Essex serving a population of 2.3 million, an 'Echo Sticker' was introduced as a standardized documentation tool. Affixed to the front page of CL notes, the sticker features tick-boxes for the five parameters along with a free-text section for additional details (figure 1). Stickers were distributed in high-traffic areas—including the CL, loading bays, and on TTE machines in the cardiology ward. Baseline data were collected before the sticker's implementation, supported by electronic and verbal reminders to CL staff. Data were then collected again after implementation. Results A total of 88 OHCA cases were included, with 46 cases pre-intervention and 42 cases post-intervention from October 2023 to June 2024. In the pre-sticker group, TTE was performed in 97% of cases; however, only 24% of the results were readily accessible, with the remainder either not documented or included within the angiogram report electronically. Documentation of key parameters was inconsistent: LV (52%), RV (10%), valves (13%), aorta (7%), and pericardial effusion (23%). Post-intervention, statistically significant improvements were observed. Accessible documentation increased to 54% (p=0.004), while documentation of key parameters improved as follows: LV (79%, p=0.01),RV (60%, p<0.0001), valves (54%, p<0.0002), aorta (35%, p<0.0007), and pericardial effusion (50%, p=0.01) (figure 2). Feedback indicated that the sticker's standardized, clearly identifiable format enhanced clarity and expedited data retrieval during handovers. Conclusion The introduction of the echo sticker significantly improved the clarity and accessibility of TTE documentation in OHCA cases. This standardized approach facilitates rapid clinical handovers in busy settings and underscores the importance of systematic documentation. Continued communication and regular reminders are recommended to maintain and further enhance compliance.